Women in IR

Episode Transcript

Hi listeners. I am Dr. Barbara Hamilton. I’m here live at SIR at the Cook booth with Dr. Kathy Kroll and Dr. Sarah White, and we represent three different pathways–three different career paths–within IR, and we are just here to inspire other women to join us in the world of IR. And we want people to feel supported by other women in IR such as ourselves. So, Dr. Kroll, can you tell us a little bit about yourself for those that don’t know you well, and you know, what was your practice like? And you’re retired, correct?

Sure. Well, first of all, I’d say I am really honored to be sitting here with two of the rock stars of IR. It’s just my pleasure to join both of you. I am retired from clinical practice now. I practised for 31 years in Indiana, always in private practice–a variety of practice modes, I guess. I was first in diagnostic radiology and did some diagnostic and some interventional. I then joined a different radiology group and did a hundred percent IR. I eventually joined a vascular surgery group for about ten years, also in private practice, and had one of the first outpatient labs–freestanding labs–and was really part of developing that methodology that allowed us to have payment for those. So that was a fun time. And in that period I got really involved in clinical trials, so did a lot of firsts in the state of Indiana. I eventually went back to radiology, joined a radiology group, and was a hospital employee. So I sort of had a lot of different practice models.

What a career path. I could just ask you questions for hours.

I eventually got involved with the SIR, which was a godsend for me, and got a lot of support from male members. When I first joined, I was one of about three women. And when I first started coming, you couldn’t even be a member. It wasn’t until probably about three or four years into my career that SIR opened up its membership and I became a member. So there have been a lot of changes in my time, that are all good.

So I hear you have an interesting path to IR. Can you tell us how you ended up in IR to begin with?

Sure. I grew up on a farm and there were no medical people in my family. I was sort of told by my parents I could not do medical school, and I was a bit of a rebellion to say the least.

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So I said, I’m going to do this. And I initially wanted to do family practice, thought I’d go back to small-town. Then I got into medical school and I loved OB, was going to do OB, and then I met this guy who said he wouldn’t marry me unless I did radiology. And I thought radiology, that’s disgusting. . The people I had seen in radiology were not people I wanted to be like, but I took the rotation. It turned out I had talent for it. I could see things that nobody else in the room could see. And so I went that route, but then I sort of took a wrong turn, according to the guy, and I did marry him.

You took a hard left.

I took a hard left. He thought I would be 10 to 2, eating bon-bons, and home for dinner all the time. But–

And he did become your spouse?

He did.

Wow. What a story.

Yeah, so, and I got two beautiful, wonderful, awesome kids out of it. But I really liked the patient contact. I didn’t want to sit in a room and just look at films all the time, even though that could be stimulating. I really just loved the patient contact. And it was a time of absolute innovation. We were still called special procedures. The first balloon was done when I was a third year resident. And I said, that’s me. I’ve gotta do that.

How about you, Dr. White? So tell us a bit about your practice and if you can remember like a, you know, a landmark moment in your career that led you to decide that IR was it.

Well, first of all, Kathy, you have to know we’re your groupies because so many of us have followed you throughout your career and we are honored to be sitting here in this room with you, Kathy, let me tell you. So it’s an honor to be sitting next to you, and be your colleague now. So for me, I started radiology knowing I wanted to do interventional radiology because I had a family friend that was a neuro interventionalist, and I remember him coming home from the hospital one day and I was at his house and he just looked upset and had his head in his hands, and he was upset. And I said, “What happened?” And he said, “Oh I, you know, I had a very sick patient.” And I said, “Well, what did you do?”

And he talked–he described to me a balloon procedure. And I thought from that moment on, I want to be like Bob Segel and I’m going to do that when I grow up. And if the blinders went on, I didn’t know anything else but that, didn’t even know it was called interventional radiology. It was–I wanted to be a neuro interventionalist and do that balloon procedure, later to find out it was an interventional radiologist. And later to find out I didn’t really care for neuro, I like the body aspect of it. So that’s how I got into it. I currently practice at the Medical College of Wisconsin, where we have a really robust practice and very busy. We love drinking from the fire hose, as we call it. So I specialize really in interventional oncology, but the group, because of where we are, we do a ton of PAD ruptures.

And so I have to be fast. I like doing all of the procedures, to be able to take call. So that’s my current practice. So knowing that I had my blinders on and I was going to interventional radiology–in medical school you have to rotate through all of the rotations, and I was doing a surgery rotation at a community practice, one of the community hospitals, and I was on trauma and remember a patient came in and I was thinking, I really like surgery a lot. I liked using my hands, I liked the patient interaction. And it was a pedestrian struck by a car and he had a stretch injury to his left renal artery. And so the trauma surgeon said, we’re going to probably have to do an nephrectomy. And we were at three hours and like 35 minutes. So four hours is–they were–they couldn’t re-perfuse the kidney at four hours, they were going to have to do an nephrectomy. And so, you know, I was a medical student, it was a community hospital, there wasn’t much going on. So I said, “Well, can I go down to the IR suite?” They called IR, one man–interventionalist–one nurse, and one tech. It was a dark room, patient wheeled in, the three of them by themselves started doing the case. And of course, as all of us do in interventional radiology, when we see an extra person, we’re like, “Can you go to that closet and pull that–pull that out and grab that third catheter from the back?” And so I thought this was fantastic, he was engaging me, which really he was just using me right as cheap labor, as a circulator. And he did his initial angiogram, renal angiogram, and there was no flow to the kidney. And I thought, oh, this guy’s going to have to get nephrectomy. Got a wire across it and stented it, and you know, within two minutes he had re-perfused the kidney.

And you had helped.

And I had–well, I did do the injector. I did push the injector button. In the final picture, he had re-perfused a kidney and I gasped and I– “Oh!”–at which point he said, “Can you come to all my cases? This is amazing.” And at that moment I knew surgery was not what I was going to do and this was my field. And it really solidified that my blinders were correct and I kept my head down, and here I sit today as an interventional radiologist, all those years later.

That is a great story. I love that.

How about you Barbara?

Yeah, just to introduce myself. So I am also private practice. I am in Southern California. The first introduction to radiology for me was I fell in love with diagnosing on a chest x-ray during pathophysiology in medical school. But before that, I didn’t know what radiology was. I didn’t even think it was gross. It wasn’t even in my mind. And then when I took a dedicated, you know, month through radiology, that’s when I encountered the interventional suite. And I could not believe this wizardry that I found there. I saw this guy doing a fistulagram and I thought this guy is a wizard. Like there was no other word for it. And I just knew. I was sucked in instantly. So, now I’m at a level two trauma center in the Palm Springs area, and poised to become level one this year. And it’s pretty exciting.

Buckle up. Yeah, get some gel foam .

We have all the gel foam. I’m going to need all the embolics. And you know, it’s been an interesting ride through Covid. I just became a leader at my institution relatively young in my career because, frankly there were just leadership voids. And then, so I started to talk about that a lot. I wanted to demystify our career for people. That’s why I started writing about it and started a blog. So some people may have seen my Tired Superheroine handle. Cause I really identified with that, especially as a young mother. You know, sometimes I’d be waking up at two in the morning to feed my baby and other times it was for a trauma patient. And they’re both just, you know, incredible ways to spend your hour at two in the morning. So ,

Well I remember after I had my first–my first, my oldest, who’s now seven, I was on maternity leave and you know, they had to get up every two hours, and he was every two hours. And people said, oh, aren’t you exhausted? And I was like, do you know how amazing it is? I have to get up. I feed him and then I put him back and then we get to go back to sleep. There’s no poop, there’s no blood, there’s no screaming, there’s no yelling, and it doesn’t smell bad. And I don’t have to leave my house. It’s amazing. Like this thing that IR has trained me to not sleep, it’s great. Maternity leave was fantastic. I was so productive. I think I published more papers on my maternity leave because I was at home, this cute little baby, holding it, then I was like writing on my computer. It was fantastic. So I–my first child was–the second and third were harder because then I had the first one–and the second , that’s another story.

I might accuse you of being superhuman there. I mean, not everybody–for the students listening, it’s not going to be the new baby experience for everyone. But yeah, I was pretty fortunate as well. It was like a healing process. And actually at the end of my maternity leave, the chair said, you should be chief of the section. Because I–I just couldn’t believe that could happen. But you know, of course a year leading up to that, when you’re doing all the call and answering the questions, it naturally happens. So just for people listening, that can actually happen. I thought that was pretty miraculous. Rght place at the right time.

Well, I can tell you the other thing. When I came back to work after maternity leave, you have the struggle of how do you maintain what you had done prior. And I was a busy clinician and am a busy clinician, and one of those OCD people that doesn’t like to leave a dictation left undone, a clinic note unwritten. And so that would mean I would be leaving at nine o’clock at night. And so I’d leave at 6:00 am and get home at nine o’clock at night. And that was not sustainable for me. So I–my little self marched myself into my chairman’s office and said, “I need a homework station.” And he said, “Turns out we’re getting them, but the person slated to get the first is the abdominal imagers because they need it.” And I said, “That’s nice. Can I have it?” I mean the–like, right? This is a mama, like fighting for her baby. .

Right.

He said, “If you go clear it with your partners, because you’re going to be the only one and IR to have it, and the abdominal imagers, and they approve it, then yes.” So I marched myself in, talked to all my partners and basically said, “I’m going to get this, are you okay with that?” And they said, “Sure, yeah.” Scared of mama .

They’d just come back from maternity leave.

As they should be.

I walked over to abdominal imaging and said, “Listen, I can’t sustain what I’m doing and for me to be successful in this life, I need to have a homework station. Are you okay if I get the first one?” And he said, “Yeah, I totally get it, Sarah. Yes.” So I got the first homework station, I still have it to this day. They tried to take it away from me once and I almost had a nervous breakdown, but still.

So I leave the hospital when the cases are done. I go and–with my kids, you know, from the time that I get home until their bedtime, and you know, put them off to bed. Once they go to sleep, then I’m back down dictating. And that’s how I have been able to continue being efficient. Now my partners would tell you, “Sarah, dictations don’t need to be signed off the same day.” That’s my personality. I can’t change my personality. So I do that, but I have really had the amazing support of my chairman and all of my practice partners to be able to do that.

So you advocated for yourself so well.

No, my baby.

. But still being able to keep that value that you hold.

Right.

That like you need to get the work done. Because I know that feeling you–you’re worried that say that ablation patient could come back to the ER and nobody will have your note.

Right.

And that’s–it’s great that you were able to hold that, you know, keep your values intact, basically. And practice the way you want to.

Right.

By advocating for yourself.

Well Kathy has stories of taking her kids to work, right?

Oh, I used to all the time. Yes. Oh yes.

Tell us about that.

Before I do that, I want to come back to something you said. You said you got the position because you were in the right place at the right time, but you left off that you were the right person with the right skills in the right place at the right time.

I guess, in a way.

No, I think we–

That doesn’t always happen that way, right? If there’s a lot of competition or at different centers. And I feel like we’re–yeah.

I think we tend to deflect credit sometimes. And I want you to make sure that you take the credit because we–

It just seemed unreal, you know, just a couple years into my career to be the chief of the section. It’s like, well–

But you were clearly the right person. You were clearly the right person. So yeah, I used to take my kids in. I had a babysitter, but she would leave at five o’clock. And then I didn’t have any backup. I didn’t have family. I had a husband, but he never came home. He was not responsible for kids or feeding them. So I’d get home, pager would go off, and I was on call every other week, sometimes more than that because my–the other partner that did IR was on the golf course. So they would call me, right? Because I’m home, because I have two kids. So, and I go with these two kids, do a big case. They’re not fed, they haven’t done their homework, haven’t gotten their school projects done. And they’re sitting in my office while I’m doing cases . And my son would–they’d look at the x-rays. They kind of knew how to read x-rays when they were like two and three years old. .

That is so cool.

And and my son is a diagnostic radiologist now.

I’m sure when you were pregnant, he was listening. I know he probably heard everything you said.

He loved the mammos the best, even as a one year old .

. Oh, really? I wonder why.

I know. It was funny.

So funny. So they were–this was throughout their childhoods.

Yes. And like Sarah, you know, I was working, and I’d go in–honestly, I was embarrassed. I didn’t really tell people how much I was working. I’d go in and it’d be four in the morning and I’d try to leave so that–by the time they were in high school they were doing sports and music and theater and all this stuff. And they had cars, so we’d all meet at a restaurant where we’d sit and then have a really good conversation, deep conversation. And then they’d go to their practices and I’d go back to work and–but we made it work. I was not the best mom. I think you guys probably had a better balance than I did. It was every day trying to balance and I’m not sure I ever got it quite right, but it wasn’t for lack of trying .

But what you just said demonstrated quality time.

Yeah.

Like they had your full attention.

And when I was off, I was off with them. I was not off doing something for myself.

That’s hard too.

. But I was committed to that at that moment. And now they’re grown up. There’s time for me.

You’re a Saint .

Definitely not . Definitely not.

Sainthood is not–yeah, being saintly is not required to be in IR, I can tell you that. Yeah. Personally .

And we shouldn’t aim for that. We shouldn’t strive for that.

Sarah, how about you have? How have you balanced that kind of quality time with your kids? I’ve heard you speak about, that, you know, you do–segment out your evening so that you have dedicated time for them and there’s nothing else.

Well, I think I had a really good mentor, Reed Omary, early in my career and, you know, as the triple threat that I try to be–education, research, and clinical care–and he sat me down one day and he said, “Sarah, I’m going to tell you something and this is going to come as a shock to you. But you can’t be good at everything all of the time. Sometimes you’re going to be a really good doctor, sometimes you’re going to be a really good researcher, and sometimes you’re going to be a really good mom. Forget the education, Sarah, because mom has to go in there.” And I really thought about that a lot. And so sometimes I’m a really–as Kathy said, I’m not a good mom–because I’m at the hospital for 36 straight hours, on call. And I don’t even give them a thought, right?

Because I’m so busy. And when I’m home, I’m home. And my phone goes off and I’m not dictating and I’m not constantly doing everything else. We’re reading “Humphrey the Hamster” and, you know, talking about their day. And sometimes I’m a really good researcher. So I think I give myself some grace. I also have this delusional thought that by being ambitious and being successful as a woman, with a career, that I’m teaching them something that’s invaluable to them.

Absolutely.

And it’s not–I don’t feel like them being away from me is, you know, depleting them of their mom when I’m with them. They know that they are my everything and they know that I–when I’m not with them, they are my everything. And so, you know, people said, “Well, do your kids know you love them when they’re not with you?” I say, “Oh, for–ask them. Ask them.” And they know they–“mom loves me with my whole heart. And even when she’s at work, she thinks about me.” And they know what their–they know beyond a doubt that even if I’m at work, that I–that they are my everything. And I think it really gives them an appreciation for–that they are not the most important thing in the universe. So it gives them some perspective that there are things that are more important. And kids I think need to know that, that not every kid gets a trophy. And sometimes you have to wait for mom and sometimes something else comes up, some patient is bleeding to death. And you know, what I am most proud about my kids is when I come home, they say, “How is the patient? Did they survive?” And that to me touches me more than anything because I have empathetic children that care about the same thing and that I care about. So kudos–kudos to my kids for dealing with me. They’re amazing. They’re here. If anyone sees three little ones running around, they’re mine.

Right. I can’t wait. How about you, Barbara?

All of those lessons–wow–that they’re learning before the age of seven. I mean, that’s incredible. And I would challenge what you said about not being a good mom when you’re not there for 36 hours. I mean, not to be argumentative, but I so say if you were a man who is providing for the family and you’re away for a week, would anyone think twice about that? So that’s been something I’ve thought to myself, you know. And I haven’t been away for 36 hours. I guess I don’t work anywhere near as hard as you do, either of you . But you know, like providing for the family is a legitimate thing. And I think as women sometimes we are like not allowed to think that way or might not be seen that way. It’s kind of interesting. But I think it is such a valuable lesson to know, like priorities. Someone’s bleeding to death. Yes, mom loves you and will take care of whatever concern you have too.

How do you balance?

I do try to be very present with him when I’m there. And he has taught me to slow down. Like early in my career, I, especially training on the East coast and being from New Jersey, I just–nothing could be done fast enough. I’m very impatient, very like, incisive and just–you know, having a toddler, everything goes at their pace. And if you try to force it or speed it up, it slows down . And so it’s been a really–I love that lesson because I really needed it and I–people were trying to beat it into my head at work. You know, there was like a–I work in southern California, I don’t work in New York City, so like, people were not always working at the same pace as me. I would get frustrated. So like some of these things, the parenting lessons and the IR lessons, bleed together so nicely sometimes. And yeah, so it’s been a phenomenal experience. So just experiencing his childhood, learning, you know, how he’s developing, all of these things have been really just so engrossing, that it naturally happens. And I feel like I’m a good mom. Like I just know, in my core.

Well, I can tell you the lesson that I’ve learned from my kids is exactly the same thing. You know, you’re trying to feed your baby and do something else, and I’m like, “Why is he crying? Why is he crying?”

And they feed off of your energy. And so as good as I am at deescalating in the IR suite, so–as things heat up in the IR suite, you will see me deescalate. I calm, and I’m the calming presence. So if somebody’s crying, and the patient’s a mess and the fellow’s, you know, stressed out, I can walk in and it’s calm. And I’ve figured out that you can do the same thing with your child. I didn’t get it. I’m getting it more and more that my kids feed off of me. So if I come home from work all riled up, they’re all riled up. “How are they riled up? I was –I need them to be calm!” Take a breath and take a minute and think, “How do I deescalate at work? Okay, we’re going to deescalate.” And it doesn’t matter. I know I’ve got a grant due tomorrow–

It’s a broken banana–

And we’re going to read the book–

It’s not a bleeding patient.

We’re going to read the book. We’re going to be quiet and you can get so much more out of spending time with your kids if you’re not stressed out about all those other things because they can totally–they totally feed off of it. They feel it.

Oh yeah, they feel it. My son looked up up at me one day and he goes, “Mom, I know one thing for sure. I am never going to tell my child, hurry up.”

.

Okay. Lesson learned.

Guilty, yeah. So I guess we can transition to the next question that I was thinking about, which is, have you ever had any misgivings about your career path? Whether it was deciding to go into IR or maybe further along the way? Sarah, do you want to start?

Well, I can tell you when I was making the decision about interventional radiology, you know, I was a young woman and it is a male dominated field. There was Kathy and there was Anne and there was a couple of them. But I thought that as a woman with radiation exposure, that I would never be a mother. And so we had some very difficult conversations, me and my family and–that being my mother and uncles and aunts and other people. And I said, you know, I don’t know that I can do IR because I might want to be a mom, didn’t know. And they said, “You have to do what you love because–let’s say you go into family practice because you want to plan for having a family. Let’s say you can’t have kids. Let’s just say now you’ve dedicated a career to something you don’t love and aren’t passionate about for something that’s a what-if.”

And so I made the decision, you know, in my mind thinking, well, this is what I’m passionate about. This is what I love. And if kids don’t happen, well. And if I can’t, okay. It turns out you can. I’ve had three beautiful–as I’ve said before–children. I operated through all three pregnancies wearing double lead, which was super amazing. But I did ruptures, I did Y90s there. None of–my practice didn’t change other than I had to sit on a stool during my eighth and ninth month of pregnancy, and I shifted my call schedules around. But I think the misperception that I had was that you couldn’t be a mother and manage call and get pregnant while you were radiating, you know, having–being in radiation fields, that was certainly something that I had to get over in my own head.

Do I have misgivings? Yeah. Every–you know, every time I get woken up at two in the morning, “Why did I do this goofy thing?” And you get up and you get out of bed and you get there and you’re cursing and you’re–under your breath–and the patient’s dying and you’re like, “Ugh, why did I do this?” And then you find the bleed and you put one coil in and the blood pressure goes from 60 over 40, to 80 over 50, to 120 over 70, and the patient rolls out of suites. And then you go see them the next day, they’re extubated, and you get to meet their family and you get to look their children in the eye and you think, “Yeah, I did the right thing. I chose the right thing.” So that misgiving, and–“I’m sorry I cursed. Sorry I cursed about that last night. They needed me.”

But certainly, I mean, it happens on a daily, if not weekly basis that you’re like, oh, why did I do this to myself? And then you see the–you look in those family member’s eyes or the patient’s eyes and you realize there’s nothing else that I should have ever done with my life.

Beautifully said.

Very, very good. Yes.

That really paints a picture of–

Yeah.

I mean exactly what you can live every day as an IR, just get to save a life and walk in the room the next day and–

Yep.

So I don’t think I ever had any misgivings about what I had chosen to do. I was told I couldn’t do it many times, many times. And so being there and being able to do it, I felt blessed every single day, like, “Look at me, I’m here.” Right?

So the people telling you that you couldn’t, weren’t the decision makers ultimately, they were just naysayers?

Yeah. Starting in childhood. Girls couldn’t do medicine. And then IR–like I said, I had this stubborn streak and I sort of said, “I’m going to do this whether it kills me or not.” Sometimes it almost killed me. But I went home every day knowing that I helped somebody, that I help people. And it felt like I had a lot of empathy and people really would say, I couldn’t have done this if you hadn’t helped me. I would pursue and and keep going until I could help them understand what we needed to do. And that they–they went through with it. I didn’t like the politics. There were a lot of politics that flared up through the career.

Like with your private practice group?

Right. Different groups and the hospital and you know, having administrators who were 20 with no training tell me that I couldn’t decide what was an emergency. Like, “Are you kidding me?” But I offset that by getting involved with the Society. I also had diagnostic partners who are like, “This is so boring. I’m 35 years old and I just do the same thing all day. It’s a production line. I’m so bored I can’t stand it.” And I kind of thought, that’s on you. Any of us can get bored with what we’re doing. But IR was different. I did thousands of stents, I did hundreds of angioplasties. But they’re all different. They’re all–you have to look at each individual one. It’s not just, yeah, there’s a lesion, I’m going to stent it and I’m done. It’s a lot of thinking. And then getting involved with the Society was a huge positive in my life.

There were all these people that were so bright, and I never felt like I belonged in that and yet they welcomed me in and they would say, “Why don’t you do this?” Like, there’s no way I can do that. Then they would go, “Of course you can.” And next thing I knew I was doing that. And it was just–I do not regret what I did, ever. I loved what I did. I absolutely loved it. There was something new every day. It quickly became known that there’s a new girl in radiology downstairs and if you’ve got a problem, just go ask her how to fix it. You know? And all these old guys came down and the clinicians were wonderful. They really allowed me to experiment and try different things and build new practices. And I had a lovely practice. Everywhere I went I just had a lovely practice.

You were able to build that trust with your referring clinicians easily.

Yeah.

I found that as well. That I–I guess I expected a little bit more pushback, but maybe that’s why tough training is so good, you know, because it just gives you that backing where–I’ve seen this before, or I’ve gotten pushback before.

And you have confidence in what you’re doing. You’re well trained.

Yes.

And you know what you can do. You know what you can’t do.

Mm-hmm. Yeah. But I think that also speaks to women, you know, we always undersell ourselves. As Barbara, you have done already, and I have done, and Kathy, you have–all three of us have done it during this podcast alone. But I think having the–that those partners that see the potential in you and see the skill that you bring to the table–I mean, my partners have pushed me beyond what I ever thought I could do. I never thought I could do a ruptured aorta. I mean–and I’m doing them, you know, standing side by side with them and they’re asking me questions and I’m like, “You’re the aortic guy. What are you talking about ?” But to have that, those partners that are just amazing. I mean, I think one of the proudest moments of my career was watching Bill Rilling give the Dotter lecture, you know, just yesterday and Parag picked him.

I mean that–you can’t get that anywhere else but having these wonderful partners that support each other. And the look–I mean, I have a picture of the two of them when they shook hands up on stage, it’s just–I am just so blessed to be with these–this group of such talented individuals. And I think you can take it one of two ways. You can, you know, be really, you know, worried about, “Oh, what they’re judging me and they think I’m not as good as they are. And–” I don’t really–I mean, I take every moment with them and, “Can I double scrub you?” and “Come help me?” And you know, now they do it to me all the time. “Sarah, come in here.” We did a GI bleed a couple weeks ago and my senior partner said, “Get in here. I need your help.” Yes.

Yes.

Yes, I’ll help you. But they’ve pushed me, certainly, to join SIR very early. I think I was two or three years out and I became chair of the clinical research and registries division, the foundation. I was like, what does the foundation have to do with me? Like, I don’t know anything. And you know, it really–it was their support saying you can do this and you’re smart and your voice needs to be heard. And so I think having a really robust partnership with your colleagues is really wonderful. And I can’t say enough good things about my partners.

And getting involved in the society like bridges that gap for those of us in private practice too. Because you know, say where I am, sometimes it can be a revolving door. Where it’s hard to recruit where I am and sometimes people don’t stay or you’re the only IR for miles . And it really has given me a huge network of people to get over maybe that imposter syndrome..

Well I think Curt Bakal said it really nicely yesterday when he accepted his gold medal and he said, “When I go to those meetings, they’re my friends.” And you know, Covid was so difficult for all of us for so many different ways and reasons and I didn’t really think about it until I was actually at a meeting. I was at Paris a couple weeks ago and to be with my friends, right? These are colleagues, you see them in the hall, you don’t consider them, you know, they’re–are these my friends? They are your friends. And we went out and had dinner and it was like, this is the best time I’ve had in three years because we’ve been locked in Covid and stressed. And to just be at a meeting and talk about similar things and you know, pushing stents and ureteral whatever–double Js, and I mean–that’s who we are–

You speak the same language.

Our core. We do. And it doesn’t matter who you are, it doesn’t matter what continent you practice in. I mean, it’s just amazing.

We share the positive and we share the negative. The same problems occur everywhere, and being able to talk about that with people who understand is very affirming. And then you just become friends.

Yeah. And Bakal says he loves these meetings because he gets to see his friends and–yeah. You know, walking around SIR you see it with a new light now that I–you know, now that he said that, you’re like, yeah, these are all my friends. Yeah, yeah, they are. I mean, I don’t know how many people I’ve hugged in the last two days, but I’m like, “I love you all!”

Sarah, you’re not a hugger. I’m like, I am now . I am getting to be there.

I love it. Have either of you experienced burnout?

I did. I definitely did. And I kind of put myself in that position. Like I said, I have this stubborn streak, whether it hurts me or not. For a while I was working probably 20 hours a day. I was on call every night. I was getting called in and after I’d go home at one in the morning, I’d get called back in. I had to be back in at six. And if I was going to keep practicing there and I couldn’t–I didn’t really feel like I could move my kids at that point. So I experienced burnout more than once in my career. How did I get out of it? I just kept going and just kept saying, “This is–I’m choosing to do this. Nobody’s making me do this, really. I’m choosing to do this because I want to do this.” Not very smart, maybe .

So you didn’t have the help you needed. Like you were–you were the IR.

I was the IR. The group said we can’t afford to hire somebody else because they were making two or three hundred extra thousand dollars off of what I was doing. They were all going home. They were surgeons. I was the only radiologist. It was a big political snafu, but it was the way I could keep practicing and could keep supporting my family.

Mm-hmm.

I mean, I think we’ve all had burnout. And burnout comes in different stages of your career with different things that you do. You know, I think you wake up in the morning and–I never thought I could, you know, step away from practice and I always want to be on call and over the last couple years I’m like, I could not take a call. I could not be on call. That wouldn’t be the most horrible thing that ever happened to me in my career. And then I would take a call and I’m like, I love call. It’s so–I get to see the patients and the families. But I think you just have to reinvent what is meaningful to you and think about what really drives you and what you’re passionate about. You know, I never thought I would be an administrator, vice chair of research.

And again, my partners pushed me and said, you can do this and you need to do this and you’re the right person for this. And I’ve really liked that piece of the career, my career. I became medical director of the vascular access team. Again, pushed into that role, thinking what do I have to offer the vascular access team? And we started with a 20 group nursing team and now we’re almost 40. At the time that I became medical director, they did IVs or PICCs, that was it. Now we have a PICC policy, a midline policy. They do ultrasound guided IVs. There’s a midline–you know, we did this whole midline initiative and they’re a consult service. So no patient gets anything inserted into their body unless they have a consult. And so we really changed the face of vascular access in our healthcare system.

And then all of a sudden you realize that as an administrator your footprint is bigger than what you could have done with a single patient. And so what I didn’t know about administration and the headaches that come with it is that your footprint gets bigger. And so now from there, vice chair, I’ve just taken a role as associate dean and so now it’s like, oh boy, condolences to me or congratulations.

Congratulations.

Congratulations.

Either way, we don’t know.

Wonderful.

But to–so that’s, you know, I never thought I would be an administrator, but I think, you know, you have to–when burnout comes, you have to figure out what’s making you happy, what are you passionate about, what gets you up in the morning. And the associate dean was that I wanted people to be accountable, held accountable, for their actions. I wanted the highest quality care and how can I do that?

So I am the Senior Medical Director for Programmatic Excellence at the hospital and Associate Dean for Faculty Affairs, and so part of my job is to go on and review programs and to figure out how to make programs really shine and do better. And whether that means change in staff, whether that means getting more resources. So it’s really strategy and how do we get people to shine. And I really like that. How do you make somebody who maybe is struggling, how do you make them successful? What do you have to do to get them there? Some people you can’t, which is a change in staffing. But it’s really fun to be able to make those decisions and help those people and see the change. Just like I had done with the vascular access team, you know, a really struggling department that now is rising and becoming a real star of the healthcare system.

I think that is a way I got out of the burnout is, one, seeing the patient’s face. And I always go on rounds when I am really like, oh, I can’t do this anymore. I’ll go round. I’ll do walk rounds and I’ll go see the patients on the floors. I’m like, okay, better . And then just reinventing what I do every day and what’s making me happy and you know–Is being on the whatever committee making me happy? No. So that’s gotta go.

Mm-hmm.

And this new thing is going to come in, because that’s what gets me going in the morning. ,

That’s great that you’re able to make an impact at the strategic systems level because I feel like that’s at the heart of so many people’s burnout, and so it’s brilliant that they have you in that role to actually have someone oversee that.

Mm-hmm. . We’ll see. .

So you’ve just started that role?

Yeah, I was doing the work for a while. Now there’s a title.

Oh, that’s great.

That’s how it happens, right?

Yeah.

That’s how it happened to me.

How about you, have you had burnout? Barbara?

Definitely, yeah. And for me it came when I felt like I didn’t have control over my destiny. It was like you, they said, yeah, we just can’t hire another person. And just feeling like I was always working more than I wanted to. Which early in your career is great experience, but then I think as you settle in to getting closer to mid-career, if I’m–I guess I’m flirting with mid-career now. I’m nine years in and it starts to feel like you just need to get at a more sustainable level where you can really, you know, hum along and not feel like there’s always that stress. Like too much call for example, or–yeah. Because then you just get grouchy on the phone and people start complaining about you

Or, you know, my way was, I just never planned anything.

Oh.

Because I was going to be called out of it and then I was going to be mad and I didn’t want to be mad, I didn’t want to be short, so I just didn’t plan anything.

Kathy, that’s me too. My calls, I’m like, nope. “Like you won’t even go have coffee?” No, because then I’ll get mad.

Right, right.

And now they text like, “Aren’t you mad you got called in?” I’m like, nope. Because I didn’t plan anything and then I don’t get mad. You just have to realize what ticks you off. Right?

Indeed.

See that’s brilliant, knowing yourself. Because for me, what–it’s the opposite. I feel like if I actually continue, if I do go to the coffee or the dinner, then I’m called out halfway through. I feel like I got to go. So I’m the opposite, is it? So I guess that’s just saying, you know, see what works for you.

Yeah.

So I’d like to ask Kathy, what’s your biggest accomplishment in your career so far? Or what are you the most proud of?

I’m the–I am the most proud–

Besides your kids.

–of my kids. And, you know, I need to say that because they gave up a lot, but they turned out great. I have four beautiful grandkids and it’s my joy and my happiness. What I’m proud of–proudest of I think is, you know, I did a lot of firsts and I did build some really nice practices that were very successful. And I think in the SIR, I hope that my leadership was to build consensus and if I saw vision, to try to get other people to buy into that vision and then let them fly with it and make that happen.

And what do you want your legacy to be?

So my daughter says my legacy will be–my epitaph will be, “She was good at coding.” .

True.

So I’m trying to work beyond that.

That’s cute.

But I hope that people remember me as someone who was a good, empathetic, kind person, who worked hard and did her best.

Check. You’re there Kathy.

Thank you. How about you?

Well, I would say when I became a full professor, I thought, oh, it’s just another, you know, another milestone that you have to hit to do academic medicine. And we have a women leaders group and I got this basket and it was from, you know, the women leaders and in the basket was a little pin and it said 227 and I got a mug and some–one of the board director’s wives had done this–does pottery, and she had hand-painted me a mug and they sent me–there was like five cards in there and what they wrote was that, “You are the 227th woman to become full professor at the Medical College of Wisconsin.” And at that moment it hit that this was not about me becoming full professor, this was about the message to everybody coming behind me that this is possible. There’s a glass ceiling, you break it, you you’re not held back by kids, you’re not held back by anything. You know, I was–I’m a full professor, I’m a full–hopefully tenured, in July–professor at 12 years out of my fellow my fellowship training. And it’s not about me. And now when I, you know–I’m FSIR, I’m FCERSI, and people, “Oh, you’re just title,” you know, “You’re just going for titles.” And it’s not about that anymore.

You have a lot of letters. I mean, to be fair.

But it’s not about that. I mean, I push really hard because, you know, FACR–there’s not a lot of women FACR. And so when Meredith came to me and said, “You know, I would like to see a lot of women as FACR,” I said, “Yeah, you bet.” It’s not about me. I don’t care if there’s an FACR behind my name, but I certainly want to show people that yeah, you can be an FACR, and you can be an FCERSI, and you can be an FSIR, and you can be an associate dean. And so that moment when I got that 227, I think is one of the–I would say the biggest–accomplishments because it was more–it wasn’t about me anymore, it was about the path I was paving for those behind me, that Kathy has paved for me. So that to me right now, so far, is the biggest accomplishment.

Beautiful.

And Barbara, yours?

I feel like, maybe I’ve become like a big fish in a small pond, but in my community I think I’ve made an impact. So I feel that just with some stick-to-it-iveness and getting through some political snafus and various challenges that come along with this career. Complications, staff that hate you one day, and you know, all the things that we navigate, you know–and then just being able to look back over the past several years and think like, “Wow, I’ve really impacted probably thousands of patients and saved countless lives.” And that’s–yeah, I think I could die happy based on that. But of course my son is beautiful too, so, yes.

So in ten years, Kathy, where do you see women in IR?

All positive. All positive. When I joined, honestly, there were no other girls in the room. There really weren’t. Anne wa–came pretty quickly, but for a long time we were less than 5% of the membership, and then we were like 8% of the membership for a long time. And now I hear we’re 19% of the membership. And when you look around at the med students that are here, there’s just wonderful, energetic, bright females. And I think we’ll be 30 to 40%, in ten years. But I think that we’ve proven that we’re good doctors, we’ve proven that we can have wonderful researchers and educators, and that we do make a difference and that we are needed. Our voice, our presence, how we practice–we don’t have to practice like the boys. It took me into my forties to realize that I was okay. The way I was, was really darn good, just not the way they wanted it. But I think we’ve proved that and the door is wide open and let’s welcome people in, help them, nurture them, push them up as well.

Barbara, as a champion for women in IR, where do you see us in ten years?

Yeah, I mean, piggybacking off of what you said, I would love to see women in IR just be able to own themselves more and just be able to walk into that room, even if it’s still–we’re only one or two of us in the room. Just be able to be a little more themselves in, like, a beautiful red trench coat like you’re wearing today, and lip gloss and you know, whatever. Or in pajamas, you know, in our scrubs and scrub caps, and just feeling comfortable in our skins, because I feel like that was a challenge. It’s a bit of a learning curve in the male dominated field.

Well I would say, you know, I have a female fellow right now who had a baby at the beginning of fellowship and she’s pumping, as we all did, and she’s got these under her shirt things and she’s walking around the IR suites and nobody gives her a second look. And when she was pregnant, I gave her a stool and she sat down. And so in ten years, what I hope is that this is the new norm, right? Women are walking around pumping as they’re taking consults. When I come to SIR people don’t look at me and say, “Oh, are you an industry represent? Oh, are you a nurse?” They look at me–

Who’s taking care of your kids?

Right? They look at me and they look at the young women that are attending SIR and they think, wow, this is the next generation of IRs.

The next awesome generation of IRs.

That’s right. Yeah. That seems like a really great place to wrap up. This has been a phenomenal discussion.

What fun to share the time with the two of you.

I know it’s been really fun. I just–I love hearing your stories and thank you for including me and it’s been an honor to echo both of you.

Thank you.